In Pursuit of Justice

The Brazilian government still has to take big steps to fulfill the historic CEDAW Committee’s ruling on maternal mortality.

11.21.13 - Twenty-eight-year-old
Alyne de Silva Pimentel, a poor Afro-Brazilian woman with a young daughter, was
six months pregnant with her second child when she began to experience severe
nausea and abdominal pain. When her
symptoms intensified, she sought help at a private health center. Five days
later, on November 16, 2002, after a series of egregious oversights and precarious
medical care, Alyne died. She had spent the last 21 hours of her life lying
largely unattended in a hospital hallway.

Two years
ago, for the first time ever, an international human rights body ruled on a
maternal mortality case. Alyne’s story made history when the United Nations
Committee on the Elimination of Discrimination against Women (CEDAW) compelled
the Brazilian government to guarantee all women, regardless of race or income, quality
maternal health care.

While the
Brazilian government has taken some important steps, Senator Ana Rita, president
of the Human Rights Commission of the Brazilian Senate, convened a public hearing
on November 14th to catalyze further progress. The Center testified at that
hearing, standing up as it always has for the rights of Alyne’s family.

The details
of Alyne’s death are shocking. Despite symptoms indicating a catastrophic
illness—including the induced delivery of her stillborn fetus, followed by
severe hemorrhaging, vomiting, and an eventual coma-like state—Alyne’s
condition was repeatedly discounted by medical staff at the two facilities
where she sought treatment. But 11 years later, we find that the details of
Alyne’s final days continue to illustrate an alarming reality in Brazil. It is
clear that Alyne’s status as a poor Afro-Brazilian—a historically marginalized
population in Brazil—played a deadly role in the low-quality care she received.

Afro-Brazilian
women are seven times more likely than white women to die from
pregnancy-related causes, and 90% of maternal deaths in Brazil are considered
preventable. Had Alyne’s pain been taken seriously, had she received immediate
surgery to stop internal bleeding, had she been transferred in a timely way to
the hospital—had her caretakers reacted appropriately to her condition, it is
likely Alyne would be alive today.

Brazil’s
initial response to the landmark CEDAW decision in 2011 included several
admirable actions. The government settled on an amount to compensate Alyne’s
family for their loss and offered to make certain symbolic gestures to
acknowledge that the government failed to protect her and to present a public
apology. Further, an interministerial group was created to determine a working
plan and indicators of compliance with the CEDAW Committee’s decision.

However, while the
government has expressed a sincere commitment to change, there have been no signs
that it has fully embraced and implemented the measures necessary to prevent
avoidable maternal deaths such as the one Alyne experienced. Significant
challenges remain:

Although the
interministerial working group legally operated from May to October 2013, the
group has not announced any of the compliance indicators, and the Center is
unaware of the development of a working plan to make progress toward
implementation.

A
distressing report from the Brazilian Platform of Economic, Social, Cultural and
Environmental Human Rights (DHESCA platform)
revealed that, 10 years later, precarious conditions persist in the two health
facilities where Alyne was treated.

Perhaps most importantly, 11 years after her death
Alyne’s family has still not received any compensation or acknowledgment
despite the promises from the Brazilian government. In fact, during the recent
public hearing, the government did not even send a representative from the Secretariat
of Women’s Policies that could be accountable for the implementation of the
case.

“All women—regardless of where they live, how much
money they have, or their race—have a fundamental right to timely and
appropriate maternal health services without discrimination,” said Mónica Arango,
the Center’s Regional Director for Latin America and the Caribbean.

“Alyne was
denied that right. As recognized by the CEDAW Committee in its decision, the
government must provide individual reparations as well as implement the policy
recommendations set forth in the decision.”

Today, Alyne’s surviving mother and daughter,
five years old when she lost her mother, still wait for meaningful justice in this
tragic and unnecessary death. Now practically a woman herself, Alyne’s daughter
joins millions of Brazilian women who have yet to see their government deliver
on the assurance of a basic human right.

As the
harrowing details of Alyne’s death remain an all-too-familiar story, the Center
continues to urge the Brazilian government to comply with the recommendations
set forth by the CEDAW Committee that recommend further steps to guarantee that
all women—particularly those most vulnerable to discrimination—have access to timely
and safe maternal health services.